Feb 2, 2023·edited Feb 2, 2023Liked by Katelyn Jetelina
You wrote : "Sadly, I’m starting to see denial and wishful thinking." Starting?? Personally, I think that's been happening for some time. No masks, "it's over", "I stopped thinking about the deaths". I do agree that we need to figure out a way to adjust to the fact that it's not going away, but as someone who is high risk, I just feel increasingly isolated and stigmatized. Apparently people who mask on planes are being harassed.
I just don't understand why people harass others wearing masks. I admit that I don't wear one except when required or when I am not feeling well, but how does someone else wearing a mask affect anyone else? (With small exceptions, like one of my kids who is trying to learn a foreign language with a teacher wearing a mask.) I understand people getting upset at school closures or mandates for vaccines or masks, but why in the world does anyone care if someone else wears one?
As the response of one or two veteran trolls on this substack indicate, some people seem to regard not wearing a mask and not being vaccinated as tribal markers. If you violate those shibboleths by wearing a mask or getting vaccinated, it marks you as one of "them" and therefore a threat.
Whenever I see someone wearing a mask, I don’t know if they have Covid or if they’re just being careful - so I steer clear. It would be nice if we had different color masks to signify whether one was shedding virus. Whenever I mask, I tell people “Just being careful” to put them at ease.
Terrific point BayDog. My first thought when I see someone (like myself) is not so much wondering if they are ill, but if they have a highly vulnerable person in their household and don't wish to carry a viral load into their own home. These folks immediately gain my respect. (Not to the point of a fist bump, however. ;>). RS
What if wearing a mask was just considered a normal variant to everyday life, rather than being stigmatized by tribal rhetoric? Wearing a mask is preventative: It reduces your viral load uptake. Wearing a mask is also beneficial to others: What if you have acquired an asymptomatic case and the mask reduces the amount of virus you're contributing to the circulating air? What if it's an emotional support device: Allowing you to feel more comfortable in public or more crowded spaces. What if it allows you to enter an environment where you need to go but are concerned about increased potential risk... or have knowledge of increased absolute risk?
Disclosure: I do not mask all the time. I triage the setting. Going into Sams/Costco? Probably not (but I've got one in my pocket) because that's a large space with high ceiling, and overall decent air circulation; I pull the pocket-mask out if it's crowded, though. Train/subway? yeah, mask is on. Traveling by air? Depends on the level of coughing and sniffling nearby, but generally I wear it in the terminal and during boarding/deplaning but not during the flight (there are good data on transport aircraft air exchange and circulation patterns). But I'm used to making judgement calls like that.
One thing that bothers me about the people who say that mandates don't "work" - in the sense of not directly resulting in slowing the spread of an infectious disease - is the dual role of a well-crafted law.
One role could be the direct effect - e.g. a posted speed limit could directly result in fewer accidents.
That usually doesn't happen overnight.
What *does* happen fairly quickly is the creation of equity. People who are caught speeding are issued citations and fines. This in turn gets reported to insurance companies, who charge higher premiums to drivers with histories of traffic violations. As a result, they pay for the risks they impose. That money can be used to cover losses resulting from accidents that *are* caused by such violations.
I like the concept of a well-crafted law. And in this case, seat belt requirements are perhaps a better analogy. And, yes, it took awhile, we had to grandfather in some cars that didn't have them (and as a result of one of those cars, a LONG time ago, I lost someone dear to me; yeah... I've got an opinion on that one) but over time the cars without seatbelts got them, or they stopped being driven with a couple of notable antique exceptions. The net result of seatbelt laws has been a marked decline in deaths of occupants in auto accidents, and traffic stops and appropriate fines have served to reduce non-compliance, to the point that, now, the number of stops based solely on seat belt compliance failure is vanishingly small.
So in today's climate how do we enact such a law? Especially, in, for instance, Florida or other states seeking to make masking unpopular or, eventually, illegal? For that matter, how do we enact a law that would punish a political official, for instance, a governor, for spreading false information about diseases and vaccines?
I'd just like to see a condition where we can protect people... perhaps in spite of themselves. Because protecting them means we can improve protection for those who cannot adequately protect themselves.
I think it’s the reaction to a feeling in themselves that they are looking at an “elitist” member of society who looks down upon them and diminishes them. If somebody wears a mask that person is by definition part of “that group” and are being insulting. It’s like the so-called “culture wars”. It’s nothing to do with logic. It’s a “they” don’t respect me reaction. And it’s been so politicized that it’s much worse. Prior to politicization, even if someone had that reaction, they were more likely than not to bury it or at least not manifest it in harassment. Now the politics of it had given it a veneer of being socially acceptable behavior.
I find bizarre the notion that wearing a mask to protect one's health would be somehow insulting. It seems to me that anyone taking such an attitude is simply looking for a reason to feel insulted so that they can be jerks while simultaneously seeing themselves as victims.
100% agree! It is ridiculous to harass people wearing masks, just as it's cruel to harass people who hang a Rabbit's Foot on their rearview mirror, carry a rosary, wear a Kirpan, or don a Yarmulke.
Absolutely, we should respect everyone's right to express their religious beliefs as long as they don't impose them on others.
I'm sure Dr Osterholm message is excellent but, honestly the format of listening to a podcast with all the social amenities and reading a verbatim transcript are simply too time-consuming for those of us that speed read and/or have many other duties in a 24 hr period. Thanks for the suggestion, but I'd rather read "the meat" and major points rather than issues of mortality and time left to spend with my g'children, etc. That's why I subscribe to this wonderful newsletter. Dr Jetelina knows how to communicate! RS
Agree, but you can (and should) be listening to everything at minimum 1.5x speed which youtube, spotify, audible, etc allow. Train your ears to work up to 2.5x.
There are some instances where there is good content, only through listening, and this is the solution to save time.
I'm a well-read layperson, but from keeping up with K. Jetelina, Eric Topol, Abraar Karan puts Osterholm on the health libertarian side-- and I'm not in favor of any liberatarianism, especially in the public health sector.
Ah, yes I also am in this category. During the winter months the isolation is even worse. I have not eaten inside a restaurant since St. Patrick’s Day 2020. Takeout reigns.
My son wears a mask to work to help protect me. There seems little Will to find protection for us now that EVUSHELD no longer has that protection with Onicron variants.
Luckily I am not a nurse or doctor, but I do work closely with all types of people. Some are children with cancer. If something might protect them I will do it. Period.
Dr. Strange, are you honestly citing a paper that claim "cloth masks are an effective form of source control"? In 2023, that's the paper you are sticking with?
The paper you cited is a follow up to Howards earlier piece from April 2020 "Face Masks Against COVID-19: An Evidence Review" [2], in which Howard and colleagues argued for masks based on the precautionary principle. (This was among the 75 pieces YLE promoted as proof masks work back in November 2020).
Howard, an entrepreneur, became convinced of mask efficacy before there was any data to back up his hypothesis and founded "Mask4all" [2] which claims that homemade masks can slow the spread of coronavirus, a claim which even you and Katelyn by now should accept has been thoroughly discredited and debunked.
Yet Jeremy Howard clings to this failed hypothesis. I believe he is suffering from sunk-cost fallacy, he made all these early claims, spent all this time and money making his website, conducting low tier studies like the pnas one you linked, and can't seem to accept his theory failed.
But at the risk of "attacking the arguer (Jeremy) and not the argument", have you actually read this PNAS paper? It's classic example of GIGO - that is, Garbage In, Garbage Out. This is when bad studies are repackaged into new studies.
Here, Jeremy commits the logical fallacy of "counting your hits and forgetting your misses", referencing every positive study no matter how poor it is, while omitting any study showing no benefit.
He cites Wood et al study "Face Masks and Cough Etiquette Reduce the Cough Aerosol Concentration of Pseudomonas aeruginosa in People with Cystic Fibrosis" [4] which measured bacteria (which are 60 times lager than Coronaviruses), at 2 meters (which we know Covid is airborne), using an Observational Study (very low evidence tier), with 25 people (very small sample size), which found n95 masks performed worse (!!) than surgical masks.
You consider this rigorous science? Perhaps the simulation models he includes are rigorous?
This is the state we are in, where repackaging low evidence can convince otherwise very intelligent people that their talismans and runes have power, while they ignore the evidence of the real world, where Sweden and her neighbors, with their low mask use fared better than South Korea, China, Japan, the US, Germany, and all of the other mask obsessed countries.
Cochrane review update - the *highest* tier of scientific evidence - earlier this week once again finds no efficacy.[6] Which is in line with the 100 years before we suddenly decided in 2020 that masks could work:
Quote:
"We included 12 trials (10 cluster‐RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness … Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness (ILI)/COVID‐19 like illness compared to not wearing masks … Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks …"
And..
"We pooled trials comparing N95/P2 respirators with medical/surgical masks … We are very uncertain on the effects of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness… N95/P2 respirators compared with medical/surgical masks may be effective for [influenza-like illness] … Evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory‐confirmed influenza infection… Restricting pooling to healthcare workers made no difference to the overall findings"
Yes, that's pretty much the response I expected. A study is "high quality" if it appears too back your opinion.
Your claim that Cochrane provides "the *highest* tier of scientific evidence" is an exaggeration. That doesn't make them wrong, necessarily, but it does make you guilty of cherry-picking reviews that suit your agenda. A more (ahem) fair and balanced overview of the validity of Cochrane can be found here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122457/
They have a better track record that non-Cochrane reviews, at least as far as NCBI is concerned in that 2002 article. Is that still the case? I don't know. But simply calling them "the *highest* tier of scientific evidence" without some evidence to back that up isn't especially convincing.
Snotty comments like comparing N95 masks to "talismans and runes" does nothing to enhance your argument but it does indicate the strong emotion behind it. And also suggests a lack of interest in evidence that might call that strong emotion into question.
That said, let's just assume that the review you cited is valid overall. Your claim that the Cochrane literature review "finds no efficacy" still distorts what the paper itself actually says. This quote (from the Authors Conclusions section) more accurately represents the authors' point than your selected excerpts:
"There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory‐confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under‐investigated.
"There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs. "
I would invite those interested in getting at the actual data to look at both the Cochrane literature review and the PNAS review. Perhaps the most balanced view overall comes from this 2022 paper at NCBI, which I encourage you to read: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9017682/
One could also get in to a discussion of Type 1 and Type 2 errors and the relative costs of each one, although that's a somewhat separate topic, I suppose.
Does it depend on the type of mask and how well it's worn? I agree that those blue surgical masks and even leaky KN95s don't do so much but consistently wear a snug N95 in inside public spaces. No Covid yet (N-of-1 experiment of course). I don't expect others to. But that's my personal risk/benefit evaluation. BUT it would be bad science to not be open to evaluating evidence to the contrary.
Actual scientists have been doing this all along. The anti-mask Plandemic conspiracy crowd aren't interested in that sort of thing. And, yes, it has been common knowledge all along that some masks are better than others and that they need to be worn properly.
The type of mask and the way it's worn absolutely matter. A well fitting "virgin" N95 on a clean-shaven face is best if your aim is to protect yourself.
That's my practice except I sometimes reuse an N95 (after it sits for a couple days) *IF* I cannot detect a leak after adjusting the tightness of the 2 straps. I figure that's "OK enough" going to a thinly populated local store for 10 minutes but would use a fresh one on public transportation. I suspect that in many/most "mask vs. no mask" outcomes studies, a variety of masks (and wearing behavior) are all mixed together in the "mask wearing" or "during the mask mandates" group.
Yes, it's one reason why the data are so noisy. Which some people take as a justification for saying "masks don't work." The available data for large groups are clearly inconclusive because there are so many potential confounding variables and it's morally and legally impossible to do a true randomized double-blind study for obvious reasons.
Totally agree. We can attempt to partially neutralize 'confounding' differences among cohorts by matching them on other variables thought likely to influence getting infected but (1) there are a lot of variables unobservable in any retrospective data set, that may influence the measured outcome (e.g. positive test, symptomatic infection); some of these may be part of 'volunteer bias' (for example, people who volunteer for something may believe they have more to benefit than those who don't, or for other reasons - classic problem in retrospectively evaluating health interventions); (2) the more 'cohorts' the harder it is to match them retrospectively (and the cohorts are not well defined - any mask? Specific types of mask like surgical, KN95, N95? Worn under what circumstances? How much potential exposure if masked, like indoor spaces, public transport... (3) Given the large number of variables we'd like to match on, the typical approach is to force-match a few super-important variables related to the outcome and 'propensity-score match' all the rest of them - PS is a probability between 0 and 100% that a person is in a reference group (e.g. N95 all the time when indoors except at home with people who behave the same way...yikes! Hard to specify any of the cohorts!), and then you match them with people in the other cohorts who have the nearest PS. Bottom line is, as they say, "the average of a mess is a mess."
Some are acceptable? What makes some ok and others not. Are some fake? I ask because I’ve been using KN95s that I learned about how to order on a reputable (I had heard it described as such in numerous quality publications) website maintained by a solid volunteer organization. Can’t remember its name without going back to try to find it. Was I wrong in following that advice? Perhaps you know the group I am referring to?
I've remembered and found the site I was talking about - it's called Project 95. It was interesting to read what I didn't see before - maybe they've added it since - that there is a KN94 mask that is regulated by the South Korean government rather than being governed by "self-attestation" which can be challenged by Chinese (?) authorities. "That makes the KN94 seem less likely to be counterfeit. See the discussion below. Of course it is 94 rather than 95 so I'm not sure how much less effective that would make it. What kind of mask do you use and how did you satisfy yourself that it wasn't counterfeit - to the extent anything can be "sure"? There were a couple of other interesting comments on or linked to the site, noting that up to 60% of KN95s are estimated to be counterfeit and also that even some universities and municipalities had bought or recommended masks of dubious authenticity for their students. Any thoughts?
I do remember the counterfeiting and I think I remember reading that the Korean version was more trustworthy than the Chinese one. Only now I don't even remember which was which. Maybe the Chinese were all N95s (supposedly) and were getting faked a lot while the Korean ones were KN95s and were considered pretty safe from counterfeiting. Guess I should go back and retrace my steps.
I always appreciate your approach to delivering serious information with a practical acknowledgement of what works for real humans and how we truly behave. But I think this piece (and much of the greater conversation about whether this is an "emergency") really overlooks the very real data about not just the Long Covid we've heard about—ongoing sequelae like fatigue, brain fog, etc—but the amplified cardiovascular risks, the damage to multiple organ systems, the long-term degradation ofthe immune system. I feel we can't look at the Covid picture as an acute illness that causes lots of disruptions and inconvenience. It has to be acknowledged that we're setting up literally all of society for increased long-term health problems, and that we're also rapidly accellerating those problems for those who are already immunocompromised and/or at higher risk. This goes WAY beyond it being annoying to have your kid home from daycare and is actually a *humanitarian* emergency.
Thanks for your thoughts. There are really two schools of thought on this among scientists: long COVID will cripple health systems for decades to come or, it is real but not enough to cripple systems. I honestly don’t know where I stand. Maybe somewhere in the middle. I do think the footprint of SARS-CoV-2 will extend for decades because of the reasons you said. And we don’t have the slightest clue of outcomes 10 or 20 years from now. But I don’t think that’s cause for an emergency that’s mainly administrative and financial. There are other mechanisms that are absolutely necessary to address the long term implications; I think we need to focus on those. Thanks again for your comment.
If COVID was causing vascular, heart, brain and other organ damage that was immediately apparent upon getting the virus, we’d be treating it like an emergency. But because there is a delay between getting COVID and that damage becoming apparent, it’s not seen as an emergency. This doesn’t really make sense when you think about it, though. Why should we only care about what happens tomorrow but not what happens in a year or two? Or do you think that we don’t have enough evidence to be terribly concerned about vascular and organ damage?
I have been reassured by calm, thorough debunking of some of the more alarmist worries about covid (for ex about immune system damage) debunked - but have seen nothing debunking the worries about vascular damage. Can we afford to risk repeated exposure to a virus that does that kind of damage? Or do you believe that worry to be overblown?
Also we recently learned EBV can cause MS, like chicken pox and shingles. Do we know yet if covid normally persists the way EBV and chicken pox do? I have read about viral persistence in long covid, but is it known if the virus is cleared in most people who recover within a few weeks?
1000% same. This is a cardiovascular disease. We can’t continue to “mitigate personal risk” without increased ventilation, filtration etc in all public spaces. If others are willing to roll the dice on increasing their risk of stroke, heart attack, disease, diabetes - so be it 🤷🏼♀️ but I can’t enter a public space right now (and nor can my kids) without risking long term health impacts.
I totally understand where you are coming from, and I don't think we have done enough to mitigate risk, but I also understand why it isn't an official emergency anymore. As Dr. Jetelina alluded to, if we keep calling it an emergency, people will not listen when we have another health crisis situation.
Where I live, in the Hudson Valley of New York, Lyme Disease has been doing much of what you speak of for a long time. I would love for it to be treated as more of an emergency.
I wish I lived in a society that put greater value on protecting the vulnerable. With COVID being triple the risk of the FLU, it’s a small ask for people to mask up in public spaces during times of high transmission (measured in the wastewater). Society has moved on, but the elderly and the immunocompromised can’t. While I appreciate the reasons that we are no longer in an emergency phase, I continue to be saddened by the lack of concern that one might transmit the disease to a vulnerable person causing them a lifetime of long covid. I know personally of far too many who continue to suffer. I don’t want to be a vector in the transmission chain, so I will continue to mask when COVID levels are high in wastewater.
I track wastewater in my hometown to keep track of COVID levels:
Hi Paul- Appreciate the comment. In regards to #2 three solid studies have compared the presence and symptoms of long COVID to post-viral influenza. All three found that long COVID is more common and more severe than post-viral influenza. In one U.S. study, post-viral symptoms were 65% higher after SARS-CoV-2 than the flu. Here are the links to the studies: https://yourlocalepidemiologist.substack.com/p/long-covid-mini-series-burden
It is important not to dismiss Long Covid nor overstate it’s prevalence.
Long Covid is certainly real, but it is a disservice to those affected with Long Covid to inflate how many people suffer from Long Covid.
Unfortunately, many in public health, including the CDC [1] as well as respected medical journals [2] continue to repeat incidence rates that likely overestimate frequency by several magnitudes.
The CDC regularly cites “10%, 20%, and 30%” rates, I suspect it is likely much closer to 1 in 500 (.2%). For readers of YLE, this likely sounds like an extraordinary claim, as the 10%-30% rates have become nearly embedded in the Covid Zeitgeist as a self evident truth, but I think a simple examination of the source of the claim followed by some thought experiments can close the rate gap between perception and reality.
Source Claim Evaluation:
First, let us review where these high incidence rates come from: surveys. Self reported surveys. The bottom tier of the scientific pyramid of evidence.
From the earliest Long Covid studies [3] to the most recent [1], we keep finding that self reporting drives these incredibly high rates.
Greenhalgh et al in “Management of post-acute covid-19 in primary care” (Aug 2020) writes “Around 10% of patients who have tested positive for SARS-CoV-2 virus remain unwell beyond three weeks” which was based on self reporting of an unknown set of patients in the UK who were hospitalized with acute covid early in the pandemic and then given an app from Zoe Health so they could log how they are feeling daily. [4]
I recently downloaded the Zoe app with the intention to log in daily and report symptoms of which there are 14 choices like hair loss (apparently then I have had Long Covid since 2016), lower back pain, depression, drowsiness, rashes, etc. By day 3 I forgot to login already, which is likely what everyone else who feels fine would do – forget to report to the app they feel fine. Sick people are far more likely to login.
The CDC writes “Nearly One in Five American Adults Who Have Had COVID-19 Still Have “Long COVID” (Oct 2022), citing the ongoing Pulse census survey [5].
Reading through the technical notes of the Pulse survey, a more accurate title for the CDC report would be “Of the 1 in 25 people who responded to our survey, Nearly 1 in 5 people self reported long Covid”.
That exposes one of the simple flaws of a survey, selection bias. Of the roughly 40,000 people sent the Pulse survey, only 4% responded. Looking through the questionnaire [6], it is easy to see why there was such low response rate as you apparently have to go through a staggering 39 pages of questions to complete the survey. (And perhaps explains why in the Limitations they note: “The response rate for the Household Pulse Survey was substantially lower than most federally sponsored surveys.”)
Who has time or motivation to complete such a survey? People who want their voice to be heard which heavily biases those with Long Covid.
It is no different than the common Sales aphorism that “a happy customer tells 1 friend, an angry customer tells 10”. In this case if you had Covid and feel fine, you will be less inclined to wade through a 39 page questionnaire than someone who has been unable to work since their illness.
For those who believe they feel fine and still decide to complete the survey, it’s possible another problem of surveys - “response bias” - will capture people who didn’t even realize they had Long Covid until the survey phrasing lead them to affirm a positive response.
Consider the vagueness of symptoms of Long Covid the Pulse survey lists on page 12 (PASC2):
“tiredness or fatigue, difficulty thinking, concentrating, forgetfulness, or memory problems (sometimes referred to as "brain fog", difficulty breathing or shortness of breath, joint or muscle pain, fast-beating or pounding heart (also known as heart palpitations), chest pain, dizziness on standing, menstrual changes, changes to taste/smell, or inability to exercise.”
Who hasn’t felt those symptoms in the past 3 months? I would be shocked if you randomly chose 100 people in 2019 and forced them to complete this survey you wouldn’t get at least a 20% affirmative response to this binary “yes or no” question. Indeed, similar scrutiny has found “post viral syndrome” following pneumonia [7], “long strep” aka PANDAS following a streptococcal infection in children.
I am also unclear if later questions of the survey can trigger a “positive for long covid” flag, consider the health questions starting on page 26 such as ”Over the last 2 weeks, how often have you been bothered by... Feeling nervous, anxious, or on edge?” Would selecting “yes” also group in you Long Covid group? I am not sure (if anyone wants to put a second or third set of eyes on this, much appreciated).
This skepticism is no different than how I approach vaccine injury claims. If someone tells me that 1 in 5 children suffer an injury following varicella vaccination, and upon scrutinizing their claim I see that this was based on parents choosing to reply to a survey, I would immediately (and correctly) call out the massive selection bias. This is why I remain skeptical when people use VAERS self reporting to argue against Covid vaccination. That skepticism needs to be applied equally to all claims, even against he ones we favor.
On the whole YLE has given us a comprehensive well grounded perspective in the evolution of the COVID pandemic. In my public health informed opinion I agreeit is appropriate that the "Covid Emergency" be brought to an end - extending it to May 11 is an act of generosity. This is because technically, scientifically, and in a public health sense across the country the case rate is low and there is now no surge and no new dangerous variants now or on the horizon. Also we probably have not yet reached endemicity. Case rates are low but the data is unreliable because of home testing. The current level of hospitalizations and deaths is low compared to the last three years (and may even never get lower.) Ongoing deaths will occur. Most importantly the general public (not to mention the Chamber of Commerce and the Republicans), having burnt out and been unsupportive and noncompliant when there were real risks with surges, will NOT want to pay attention now. There is no national political will or force to continue the emergency and plenty of corporate and Republican opposition.
The big problem is that the White House's policies and messaging is very deficient (to agree with the KFF observations cited). They have
(1) no announced and publicized public plan to monitor for a surge or dangerous variants (with transparent criteria and thresholds),
(2) no public plan to develop or approve a better vaccine on an accelerated basis (like the new, better Indian intranasal vaccine),
(3) no specific plan to increase vaccination acceptance and levels of Americans with the better booster,
(4) no public health strategy to protect high risk individuals (especially now that Evusheld is ineffective and off the market). They are not even articulating the importance of societal and neighborly protection of these 7 to 15 million Americans.
(5) no public, national plan to deal with deferred evictions,
(6) no national plan to deal with the 100,000s of people and children who will lose health insurance or be unable to afford ongoing home rapid tests or Paxlovid or vaccinations at commercial rates.
(7) Much NIH research but no plan to support people with LONG COVID now or to deal with the loss of their labor to the workforce,
(8) No plan to deal with the national trauma of over 1,000,000 deaths and the millions of affected family members. There is no discussion in the public square about this issue - like it never happened. (See MarkedbyCOVID.org).
(9) The COVID emergency totally demonstrated the shortcomings of our commercial, market oriented health care insurance by the need for the feds to bail out both providers and patients with huge amounts of federal cash to provide needed COVID medical care. We need to avoid any return to the old system and create a federal universal not for profit health care system on the traditional Medicare or a public utility model. It seems federal policy is unwilling to even admit this truth.
Thus there are lots of specific issues that concerned citizens and activists must pay attention to at this time of transition.
Bless your work. You are doing everything you can.
The only creative idea I can think of is for you to gather a few like minded people and have a NATIONAL TOWN HALL live steamed and on CNN or MSNBC with 5 min fact segments followed by 10 min open discussion of each issue from panelists and audience! It could change the national conversation on these issues. GAME ON?
Dr. Gordon, this is truly an excellent list of concerns. Thank you so much for weighing in. May I add a friendly amendment to #4, which is that it also does not appear there is any strategy for, or even clear communication to, those of us at higher risk because of age? That cohort is, if I recall correctly, 16% of the population. At this point, and actually not for some time, have I expected societal support, but it sure would be helpful if our federal, state, and local public health departments gave us guidance and information targeted specifically to those of us at higher risk. I’m reminded of Dr. Jetelina’s comment when the CDC changed to Community Level maps: “This map tells us when to take collective action so hospitals don’t surge. This does not tell us when to wear a mask for individual protection due to high transmission. If we are trying to prevent severe disease, those at most risk should know when they are at risk for infection.”
Great addition to the article, overall I wish I could like this twice. One disagreement I have is with respect to point #9. We don't just have a for-profit healthcare system. We have a mixed bag of partly socialized and partly insured and partly privatized and it's not working very well. Yes, there are benefits to fully socialized healthcare but there are also significant costs on an individual level and opportunity costs. I don't think there is enough recognition of the benefits derived from innovation related to for-profit healthcare and pharma in the US both for the US and the world. I agree though that the system as it is now has a lot of problems, I just don't believe in throwing out the baby with the bathwater. I would like to see a discussion about which model would best preserve innovation and the benefits that capitalism can bring while avoiding the downsides.
There's a thing that Medicare does when it finds that someone has other coverage - crossover claims. Either they forward the claim, or in some cases Medicare will front the money and recover it from the private payer. Of course, that's all predicated on the claimant having Medicare. Why? Let's blow the system open to people who don't have Medicare. If they don't, HHS and the IRS surely have everything they need to determine the correct payor. This would have all the administrative simplicity of single payer, but without the extra costs.
(1) Health insurance company contracts of insurance all generally have clauses that they are secondary payers in some circumstances, e.g. injury due to auto accident caused by others, or work place injury under work comp insurance. I believe Medicare law requires if an enrollee is dually insured Medicare is secondary.
(2) If it were not for the vigorous lobbying and political opposition of all the corporations and companies making money on the present system (UnitedHealthcare had a $20 billion profit !!!! in 2022) the easiest and simplest, and most rational road to single payer would be to enroll all Americans in traditional Medicare and make some moderate improvements.
Except that's not happening any time soon, since it would require statutory changes. Blowing crossover claims wide open would be a fair alternative and could be implemented administratively.
Do you think ending the "emergency" in May (instead of today) is to allow time for a possible XBB.1.5 surge in the next few months?
To the extent people increasingly forego vaccines and boosters, and to the extent vaccine protection wanes, our immunity wall will increasingly depend on natural immunity. It seems Public Health’s unspoken assumption is that in order to build a strong and durable immunity wall, it is necessary for those at lower risk to acquire some level of natural immunity to protect the more vulnerable members of society.
This is an important comment. You have a game plan right here on what needs to be done before the next pandemic. I am distressed that much of this is not being looked at.
After reading this post, I became a subscriber. I have been reading for a while with appreciation but hesitated adding yet another subscription to my growing stack of expenses. But your willingness to be bold in speaking about the need for societal reform when it comes to healthcare pushed me here immediately. Thank you for your voice.
"We need to invest in better filtration and ventilation."
Has literally anything been done in this regard? I see a lot of talking about its necessity but have never seen anything talking about any progress, other than some schools buying portable air filters.
On an anecdotal note, I (childless) only see those filters in some medical settings and ... all over Koreatown. That's it. Is there any invisible progress being made?
Yes, there is progress being made, but certainly in pockets. Dr. Joseph Allen (Harvard) is one of the biggest advocates for this. In fact, he was writing about this in March 2020, just no one was listening. He updates on his Twitter about progress. Also has a good website.
I was asking myself this recently when auditing a class at a very wealthy Ivy League university where hundreds of kids (no masks) were crammed into a big lecture hall with all windows shut. With an endowment in billions why not lead the way with indoor air quality mitigation? Apparently this is just not a priority.
It would be helpful to know if there was a repository of air cleaner, air handling devices that are effective in killing the SARS-Cov virus. I am aware of only two of them, UV-C and one based on PHI (photo-hydrogen ion generation, utilizing LEDs to generate the ions off of a proprietary device with a single generator device placed in the primary ductwork. disclaimer: I don’t sell such devices, but I am aware of these devices and we have used them in our home air handling system. We installed the original device with UVC/PHI combined many years ago and upgraded to the latter recently. So far so good, but we still wear masks in “crowds”(more aptly described as gatherings in our case) in enclosed Spaces. We practice distancing/handwashing and believe in the vaccines plus boosters. There is no rule that you’re only allowed one Level of protective armor. some commercial entities use, larger scale devices, most of which are the UVNC version, but I am aware of the second variety being exported to China and also used to control unwanted mold in certain cheese factories operated by the Dutch.
As an individual, I can't solution for better filtration in public spaces, especially schools (because of how they're funded) and privately owned spaces (like big box stores and hospitals).
I am saddened that the recommendations given here fail to mention filtration at any other level of responsibility besides an individual's onus. This is a tremendous misstep.
Thank you for another wonderful post. I appreciate the thought you put around what phase we’re in given our uncharted territory and lack of formal definition.
Dealing with Covid is our new normal. What I struggle with is knowing how bad transmission levels are around me. What’s the most reliable indicator? In my country, the wastewater chart (logarithmic) is at an all-time high (worse than January 2021) even though our CDC score (based on hospital bed capacity) is “low.” We’ve had a ton of rain this past month, which makes interpreting the chart iffy. Deaths are also low, thankfully, but they are backwards looking by 3+ weeks. I’ve been trying to do as much social stuff as possible outside for the last 3 years, but at some point I’ll need to return to indoor dining and events. It would be nice to know I’m doing so when transmission levels are low - but where’s the best place to find this out? Case counts are no longer reliable, and test positivity isn’t always readily available.
I’m also curious, any update on XBB.1.5? Will we have a second winter surge, and if so, will it be worse than the post-Christmas wave? Or is our immunity wall holding up better than expected?
Unless your municipality is mixing storm drain water with sewage fluids and sending both to the sewage treatment facility, the fact that "it has rained a lot" would not seem to have much impact on interpreting COVID monitoring data coming out of your sewershed.
Thanks! I don't know whether storm drain gets mixed with sewage fluids - probably not because all the rain would have diluted the wastewater and lowered the amount of covid particles on the chart. Below is a link to the chart in case you're interested, although you have to scroll down quite a ways to see the wastewater chart, which is logarithmic. It does look like it might be nudging down a little, hard to say. Also, don't people excrete virus for a while after they've had covid - probably, but for how long (weeks or months)?
My sense is my county does a great job collecting and providing information, yet it's still hard to know transmission level. My county also does a lot of other wonderful things from an equity point of view, such as free Paxlovid to the uninsured.
So one way around this possible dilution is what biobot does - they benchmark everything to a harmless plant virus that passes through the guts of animals, called "pepper mild mottle virus".
"At this rate, SARS-CoV-2 will be the fourth leading cause of death in the U.S. in 2023..."
This always bothered me. Heart disease and cancer aren't "one thing". They're a category of many different ailments, all lumped together. Accidents I have to assume are the same. Yet COVID-19 is a very specific single ailment. In previous years it looked fairly clear that one could declare COVID-19 the biggest single cause of death. Would be interesting to see when _that_ might finally stop being the case.
Over that recently as a matter of fact. Much higher than it was in the Summer of 2021 when we had vaccines but were still very, very scared. And that was before Delta and Omicron. The fact that they are no long as devastating doesn’t mean we should relax. Think back.
As we leave behind the emergency phase, it's so striking that COVID is Top 5 for causes of death, right above stroke! You're conclusion that we are also *LESS* prepared for the next pandemic due to lack of trust, misinformation, etc is quite sobering and should inspire us to do better.
Glad you said “kind of”. I am a fervent believer both in mask wearing and vaccination. But I confess, whenever I do wear a mask - which is seldom since I avoid almost all contact that might require it - I find it uncomfortable (physically) and I can readily understand the urge to not bother. After all there are many health improving things that we could do - exercise, eat better, etc. - but many of us don’t do them either, even though we know the longer term benefits.
Thank you for this helpful perspective. Yes, we will (hopefully) be in this in-between, transition phase for years to come. Please share if there are ways we can help to support improvements as we go forward. With gratitude.
NIce piece, but depressing in that "the emergency is over" thinking will end up increasing deaths still more. And while I agree that innovation in vaccines is needed, we also need to focus on developing drugs that *kill* coronaviruses. There was much optimism about this a year or so ago; now everything has gone quiet. Which is strange, because any research group or pharma company that develops such a drug will make a fortune. Might be nice to write a piece on the state of play WRT developing new ways to stop Covid, etc (not solely vaccines). Thanks Katelyn, and keep up the terrific work.
Where is the evidence that providing food to countries experiencing famines reduces deaths? The covid emergency enabled people of all income levels, with/without health insurance, to get lifesaving vaccines, therapies, tests, and to get some financial support to help if they’d missed work due to illness, etc.
This is a great post - thanks! Can you write a follow-up post about living in this "transition" world with an individual-centric set of guidelines for navigating life - with the aim of aggressively minimizing the probability of encountering long-COVID in our lives?
Right now, all I can think of is that catching COVID is bad - because it *may* lead to long COVID with a 1/300 probability (like you've written about earlier). But it leaves me feeling exposed and without a sense of control. I know if I get influenza, there are certain things I can do to minimize complications - even though tamiflu may or may not work, it's worth taking; and even though post-viral syndromes exist even with influenza, it hasn't felt historically scary like this.
- Recently FDA has moved to change COVID-19 vaccination schedule to be annual, and you wrote about it recently. Are there strategies we could undertake get non-updated vaccines more frequently if we wished (perhaps with the help of a friendly physician's referral and out of pocket costs) to reduce our exposure?
- What are the best tactics for leveraging Paxlovid in our lives? I've read in some places that a 2-week course is more effective than a 1-week course, but it all sounds very anecdotal, and I've ignored it (we've avoided COVID-19 successfully, in part thanks to columns like yours, so haven't needed this yet).
- How do we manage travel, and in general, taking risks in environments where we may expose ourselves to COVID-19 (like restaurants, parties etc.)? Is the only solution to mask-up, and avoid flying to Australia? ;-)
As someone who recently tested positive for Covid after 2 1/2 years of cautious living I really appreciate your thorough and objective delivery of this information.
I had to fly from Calif to Florida to visit my brother in the hospital and on the flight home had a passenger on my left, masked , coughing and sneezing and on the right across he aisle I had a fellow umasked coughing and sneezing .
I was double masked most of the time unless single masked or eating. tested positive three days after getting off the plane.
I am fortunately having light symptoms and even though 73 I am in pretty good health and not experiencing severe reactions.
We are definitely NOT over the pandemic despite America's frightening ability to choose to believe what matches their wish list rather than what is actually occurring.
Like the captain on the Titanic, we continue to believe that we can transform this continuing serious Covid infection - "glacier" of a problem into a "fogbank" because we " want to". Just as with Climate Change, Homelessness , Racism, and the Income disparity, " Don't Look Up !" got it right!
I had hoped we'd get a decision about when vulnerable seniors, like me and my husband, can have our 2nd bivalent booster. Our first was 4 months ago. Advice, please! (No comments by pro-Covid folks are wanted.)
We have the same question. We have answered it for ourselves, after reading what FDA advisors are saying, that the first chance will be next Fall. Some experts would even like to skip it altogether, because they don’t believe it significantly improves protection. Despite the talk of seniors being given two shots a year, I think we’ll be lucky to get one. The talk is just talk. And if it came to pass the benefits of reducing infection/transmission wear off so quickly that 2 a year wouldn’t be enough to help much if at all.
I did see the "next fall" notion... but is literally no one researching how to protect vulnerable seniors? I just might visit a pharmacy--not the one were we've had our previous vaccinations--and ask for a bivalent. If they ask what vaccinations I've had to date, I could say, "None. My grandson just persuaded me I should get one." (Do pharmacies share their vaccination records? I hope not!)
Geez, this reminds me of trying to score marijuana in 1966 and wondering when it'll finally be legalized.
Yes, I’ve has the same idea. In fact, somebody on this newsletter, responding to my question about how to get extra shots, said he just went to the pharmacy (the same one) and got another shot, no questions asked. I think just saying I don’t have my card or i can’t find it would work too. my impression is that the pharmacies don’t do a very rigorous job of policing it.
You wrote : "Sadly, I’m starting to see denial and wishful thinking." Starting?? Personally, I think that's been happening for some time. No masks, "it's over", "I stopped thinking about the deaths". I do agree that we need to figure out a way to adjust to the fact that it's not going away, but as someone who is high risk, I just feel increasingly isolated and stigmatized. Apparently people who mask on planes are being harassed.
I just don't understand why people harass others wearing masks. I admit that I don't wear one except when required or when I am not feeling well, but how does someone else wearing a mask affect anyone else? (With small exceptions, like one of my kids who is trying to learn a foreign language with a teacher wearing a mask.) I understand people getting upset at school closures or mandates for vaccines or masks, but why in the world does anyone care if someone else wears one?
As the response of one or two veteran trolls on this substack indicate, some people seem to regard not wearing a mask and not being vaccinated as tribal markers. If you violate those shibboleths by wearing a mask or getting vaccinated, it marks you as one of "them" and therefore a threat.
Whenever I see someone wearing a mask, I don’t know if they have Covid or if they’re just being careful - so I steer clear. It would be nice if we had different color masks to signify whether one was shedding virus. Whenever I mask, I tell people “Just being careful” to put them at ease.
Terrific point BayDog. My first thought when I see someone (like myself) is not so much wondering if they are ill, but if they have a highly vulnerable person in their household and don't wish to carry a viral load into their own home. These folks immediately gain my respect. (Not to the point of a fist bump, however. ;>). RS
What if wearing a mask was just considered a normal variant to everyday life, rather than being stigmatized by tribal rhetoric? Wearing a mask is preventative: It reduces your viral load uptake. Wearing a mask is also beneficial to others: What if you have acquired an asymptomatic case and the mask reduces the amount of virus you're contributing to the circulating air? What if it's an emotional support device: Allowing you to feel more comfortable in public or more crowded spaces. What if it allows you to enter an environment where you need to go but are concerned about increased potential risk... or have knowledge of increased absolute risk?
Disclosure: I do not mask all the time. I triage the setting. Going into Sams/Costco? Probably not (but I've got one in my pocket) because that's a large space with high ceiling, and overall decent air circulation; I pull the pocket-mask out if it's crowded, though. Train/subway? yeah, mask is on. Traveling by air? Depends on the level of coughing and sniffling nearby, but generally I wear it in the terminal and during boarding/deplaning but not during the flight (there are good data on transport aircraft air exchange and circulation patterns). But I'm used to making judgement calls like that.
That would be amazing.
One thing that bothers me about the people who say that mandates don't "work" - in the sense of not directly resulting in slowing the spread of an infectious disease - is the dual role of a well-crafted law.
One role could be the direct effect - e.g. a posted speed limit could directly result in fewer accidents.
That usually doesn't happen overnight.
What *does* happen fairly quickly is the creation of equity. People who are caught speeding are issued citations and fines. This in turn gets reported to insurance companies, who charge higher premiums to drivers with histories of traffic violations. As a result, they pay for the risks they impose. That money can be used to cover losses resulting from accidents that *are* caused by such violations.
I like the concept of a well-crafted law. And in this case, seat belt requirements are perhaps a better analogy. And, yes, it took awhile, we had to grandfather in some cars that didn't have them (and as a result of one of those cars, a LONG time ago, I lost someone dear to me; yeah... I've got an opinion on that one) but over time the cars without seatbelts got them, or they stopped being driven with a couple of notable antique exceptions. The net result of seatbelt laws has been a marked decline in deaths of occupants in auto accidents, and traffic stops and appropriate fines have served to reduce non-compliance, to the point that, now, the number of stops based solely on seat belt compliance failure is vanishingly small.
So in today's climate how do we enact such a law? Especially, in, for instance, Florida or other states seeking to make masking unpopular or, eventually, illegal? For that matter, how do we enact a law that would punish a political official, for instance, a governor, for spreading false information about diseases and vaccines?
I'd just like to see a condition where we can protect people... perhaps in spite of themselves. Because protecting them means we can improve protection for those who cannot adequately protect themselves.
I chose speeding and running red lights because that's an area where the violator is creating a risky situation not just for himself but for others.
Back to masking - at the very least we should be providing support to private businesses who wish to impose mask requirements.
I wear a new N95 every day to buy myself time. The joke about the two people being chased by a bear is definitely applicable here.
I think it’s the reaction to a feeling in themselves that they are looking at an “elitist” member of society who looks down upon them and diminishes them. If somebody wears a mask that person is by definition part of “that group” and are being insulting. It’s like the so-called “culture wars”. It’s nothing to do with logic. It’s a “they” don’t respect me reaction. And it’s been so politicized that it’s much worse. Prior to politicization, even if someone had that reaction, they were more likely than not to bury it or at least not manifest it in harassment. Now the politics of it had given it a veneer of being socially acceptable behavior.
I find bizarre the notion that wearing a mask to protect one's health would be somehow insulting. It seems to me that anyone taking such an attitude is simply looking for a reason to feel insulted so that they can be jerks while simultaneously seeing themselves as victims.
100% agree! It is ridiculous to harass people wearing masks, just as it's cruel to harass people who hang a Rabbit's Foot on their rearview mirror, carry a rosary, wear a Kirpan, or don a Yarmulke.
Absolutely, we should respect everyone's right to express their religious beliefs as long as they don't impose them on others.
It might be useful for you to listen to the recent podcast by Dr. Michael Osterholm CIDRAP on mask use. Like this newsletter, he is a marvelous source of data driven information. https://www.cidrap.umn.edu/covid-19/osterholm-update-covid-19
I'm sure Dr Osterholm message is excellent but, honestly the format of listening to a podcast with all the social amenities and reading a verbatim transcript are simply too time-consuming for those of us that speed read and/or have many other duties in a 24 hr period. Thanks for the suggestion, but I'd rather read "the meat" and major points rather than issues of mortality and time left to spend with my g'children, etc. That's why I subscribe to this wonderful newsletter. Dr Jetelina knows how to communicate! RS
Agreed. I ignore links to YouTube videos and podcasts. Just send me an article from a reputable source, preferably with data to back it up.
Agree, but you can (and should) be listening to everything at minimum 1.5x speed which youtube, spotify, audible, etc allow. Train your ears to work up to 2.5x.
There are some instances where there is good content, only through listening, and this is the solution to save time.
very good, I’ll give it a try. Thanks. My habit has been to slow things down when I use YT videos for music instruction. 
Yes that's one time to use the .5x speed! I do that for note training as well!
I bid .75 speed! 0.5 makes me anxious for the next note or I get sleepy waiting ;)
I'm a well-read layperson, but from keeping up with K. Jetelina, Eric Topol, Abraar Karan puts Osterholm on the health libertarian side-- and I'm not in favor of any liberatarianism, especially in the public health sector.
Ah, yes I also am in this category. During the winter months the isolation is even worse. I have not eaten inside a restaurant since St. Patrick’s Day 2020. Takeout reigns.
My son wears a mask to work to help protect me. There seems little Will to find protection for us now that EVUSHELD no longer has that protection with Onicron variants.
Properly fitting N95 masks have been shown over and over that they work to prevent spread and infection.
Luckily I am not a nurse or doctor, but I do work closely with all types of people. Some are children with cancer. If something might protect them I will do it. Period.
Which high quality studies support that hypothesis?
Well, there's this: https://www.pnas.org/doi/10.1073/pnas.2014564118 Hope that helps.
Dr. Strange, are you honestly citing a paper that claim "cloth masks are an effective form of source control"? In 2023, that's the paper you are sticking with?
The paper you cited is a follow up to Howards earlier piece from April 2020 "Face Masks Against COVID-19: An Evidence Review" [2], in which Howard and colleagues argued for masks based on the precautionary principle. (This was among the 75 pieces YLE promoted as proof masks work back in November 2020).
Howard, an entrepreneur, became convinced of mask efficacy before there was any data to back up his hypothesis and founded "Mask4all" [2] which claims that homemade masks can slow the spread of coronavirus, a claim which even you and Katelyn by now should accept has been thoroughly discredited and debunked.
Yet Jeremy Howard clings to this failed hypothesis. I believe he is suffering from sunk-cost fallacy, he made all these early claims, spent all this time and money making his website, conducting low tier studies like the pnas one you linked, and can't seem to accept his theory failed.
But at the risk of "attacking the arguer (Jeremy) and not the argument", have you actually read this PNAS paper? It's classic example of GIGO - that is, Garbage In, Garbage Out. This is when bad studies are repackaged into new studies.
Here, Jeremy commits the logical fallacy of "counting your hits and forgetting your misses", referencing every positive study no matter how poor it is, while omitting any study showing no benefit.
He cites Wood et al study "Face Masks and Cough Etiquette Reduce the Cough Aerosol Concentration of Pseudomonas aeruginosa in People with Cystic Fibrosis" [4] which measured bacteria (which are 60 times lager than Coronaviruses), at 2 meters (which we know Covid is airborne), using an Observational Study (very low evidence tier), with 25 people (very small sample size), which found n95 masks performed worse (!!) than surgical masks.
You consider this rigorous science? Perhaps the simulation models he includes are rigorous?
This is the state we are in, where repackaging low evidence can convince otherwise very intelligent people that their talismans and runes have power, while they ignore the evidence of the real world, where Sweden and her neighbors, with their low mask use fared better than South Korea, China, Japan, the US, Germany, and all of the other mask obsessed countries.
Cochrane review update - the *highest* tier of scientific evidence - earlier this week once again finds no efficacy.[6] Which is in line with the 100 years before we suddenly decided in 2020 that masks could work:
Quote:
"We included 12 trials (10 cluster‐RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness … Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness (ILI)/COVID‐19 like illness compared to not wearing masks … Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks …"
And..
"We pooled trials comparing N95/P2 respirators with medical/surgical masks … We are very uncertain on the effects of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness… N95/P2 respirators compared with medical/surgical masks may be effective for [influenza-like illness] … Evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory‐confirmed influenza infection… Restricting pooling to healthcare workers made no difference to the overall findings"
[1] https://www.preprints.org/manuscript/202004.0203/v2
[2] https://masks4all.co/how-to-make-a-homemade-mask/
[3] https://www.preprints.org/manuscript/202004.0203/v2
[4] https://pubmed.ncbi.nlm.nih.gov/28930641/
[5] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full
Yes, that's pretty much the response I expected. A study is "high quality" if it appears too back your opinion.
Your claim that Cochrane provides "the *highest* tier of scientific evidence" is an exaggeration. That doesn't make them wrong, necessarily, but it does make you guilty of cherry-picking reviews that suit your agenda. A more (ahem) fair and balanced overview of the validity of Cochrane can be found here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122457/
They have a better track record that non-Cochrane reviews, at least as far as NCBI is concerned in that 2002 article. Is that still the case? I don't know. But simply calling them "the *highest* tier of scientific evidence" without some evidence to back that up isn't especially convincing.
Snotty comments like comparing N95 masks to "talismans and runes" does nothing to enhance your argument but it does indicate the strong emotion behind it. And also suggests a lack of interest in evidence that might call that strong emotion into question.
That said, let's just assume that the review you cited is valid overall. Your claim that the Cochrane literature review "finds no efficacy" still distorts what the paper itself actually says. This quote (from the Authors Conclusions section) more accurately represents the authors' point than your selected excerpts:
"There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory‐confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under‐investigated.
"There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs. "
I would invite those interested in getting at the actual data to look at both the Cochrane literature review and the PNAS review. Perhaps the most balanced view overall comes from this 2022 paper at NCBI, which I encourage you to read: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9017682/
One could also get in to a discussion of Type 1 and Type 2 errors and the relative costs of each one, although that's a somewhat separate topic, I suppose.
Does it depend on the type of mask and how well it's worn? I agree that those blue surgical masks and even leaky KN95s don't do so much but consistently wear a snug N95 in inside public spaces. No Covid yet (N-of-1 experiment of course). I don't expect others to. But that's my personal risk/benefit evaluation. BUT it would be bad science to not be open to evaluating evidence to the contrary.
Actual scientists have been doing this all along. The anti-mask Plandemic conspiracy crowd aren't interested in that sort of thing. And, yes, it has been common knowledge all along that some masks are better than others and that they need to be worn properly.
This may prove useful: https://www.pnas.org/doi/10.1073/pnas.2014564118
The type of mask and the way it's worn absolutely matter. A well fitting "virgin" N95 on a clean-shaven face is best if your aim is to protect yourself.
That's my practice except I sometimes reuse an N95 (after it sits for a couple days) *IF* I cannot detect a leak after adjusting the tightness of the 2 straps. I figure that's "OK enough" going to a thinly populated local store for 10 minutes but would use a fresh one on public transportation. I suspect that in many/most "mask vs. no mask" outcomes studies, a variety of masks (and wearing behavior) are all mixed together in the "mask wearing" or "during the mask mandates" group.
Yes, it's one reason why the data are so noisy. Which some people take as a justification for saying "masks don't work." The available data for large groups are clearly inconclusive because there are so many potential confounding variables and it's morally and legally impossible to do a true randomized double-blind study for obvious reasons.
We could learn a lot about how insanely effective NPI's are by talking to people in the cystic fibrosis community.
Totally agree. We can attempt to partially neutralize 'confounding' differences among cohorts by matching them on other variables thought likely to influence getting infected but (1) there are a lot of variables unobservable in any retrospective data set, that may influence the measured outcome (e.g. positive test, symptomatic infection); some of these may be part of 'volunteer bias' (for example, people who volunteer for something may believe they have more to benefit than those who don't, or for other reasons - classic problem in retrospectively evaluating health interventions); (2) the more 'cohorts' the harder it is to match them retrospectively (and the cohorts are not well defined - any mask? Specific types of mask like surgical, KN95, N95? Worn under what circumstances? How much potential exposure if masked, like indoor spaces, public transport... (3) Given the large number of variables we'd like to match on, the typical approach is to force-match a few super-important variables related to the outcome and 'propensity-score match' all the rest of them - PS is a probability between 0 and 100% that a person is in a reference group (e.g. N95 all the time when indoors except at home with people who behave the same way...yikes! Hard to specify any of the cohorts!), and then you match them with people in the other cohorts who have the nearest PS. Bottom line is, as they say, "the average of a mess is a mess."
None of my N95"s last longer than a day. I was able to buy a few hundred with my flex spend account.
That, plus I've had 7 shots total.
And I'm able to live alone, thanks to rent stabilization.
I work 100% in person and have been riding crowded subways for the past two years.
Some are acceptable? What makes some ok and others not. Are some fake? I ask because I’ve been using KN95s that I learned about how to order on a reputable (I had heard it described as such in numerous quality publications) website maintained by a solid volunteer organization. Can’t remember its name without going back to try to find it. Was I wrong in following that advice? Perhaps you know the group I am referring to?
I've remembered and found the site I was talking about - it's called Project 95. It was interesting to read what I didn't see before - maybe they've added it since - that there is a KN94 mask that is regulated by the South Korean government rather than being governed by "self-attestation" which can be challenged by Chinese (?) authorities. "That makes the KN94 seem less likely to be counterfeit. See the discussion below. Of course it is 94 rather than 95 so I'm not sure how much less effective that would make it. What kind of mask do you use and how did you satisfy yourself that it wasn't counterfeit - to the extent anything can be "sure"? There were a couple of other interesting comments on or linked to the site, noting that up to 60% of KN95s are estimated to be counterfeit and also that even some universities and municipalities had bought or recommended masks of dubious authenticity for their students. Any thoughts?
PS what is the acronym IIRC?
I do remember the counterfeiting and I think I remember reading that the Korean version was more trustworthy than the Chinese one. Only now I don't even remember which was which. Maybe the Chinese were all N95s (supposedly) and were getting faked a lot while the Korean ones were KN95s and were considered pretty safe from counterfeiting. Guess I should go back and retrace my steps.
Thank you. I will use mine up.
They're much more affordable than they used to be in 2020 and 2021. I find I'm weirdly grateful to the anti-maskers for this.
I always appreciate your approach to delivering serious information with a practical acknowledgement of what works for real humans and how we truly behave. But I think this piece (and much of the greater conversation about whether this is an "emergency") really overlooks the very real data about not just the Long Covid we've heard about—ongoing sequelae like fatigue, brain fog, etc—but the amplified cardiovascular risks, the damage to multiple organ systems, the long-term degradation ofthe immune system. I feel we can't look at the Covid picture as an acute illness that causes lots of disruptions and inconvenience. It has to be acknowledged that we're setting up literally all of society for increased long-term health problems, and that we're also rapidly accellerating those problems for those who are already immunocompromised and/or at higher risk. This goes WAY beyond it being annoying to have your kid home from daycare and is actually a *humanitarian* emergency.
Thanks for your thoughts. There are really two schools of thought on this among scientists: long COVID will cripple health systems for decades to come or, it is real but not enough to cripple systems. I honestly don’t know where I stand. Maybe somewhere in the middle. I do think the footprint of SARS-CoV-2 will extend for decades because of the reasons you said. And we don’t have the slightest clue of outcomes 10 or 20 years from now. But I don’t think that’s cause for an emergency that’s mainly administrative and financial. There are other mechanisms that are absolutely necessary to address the long term implications; I think we need to focus on those. Thanks again for your comment.
If COVID was causing vascular, heart, brain and other organ damage that was immediately apparent upon getting the virus, we’d be treating it like an emergency. But because there is a delay between getting COVID and that damage becoming apparent, it’s not seen as an emergency. This doesn’t really make sense when you think about it, though. Why should we only care about what happens tomorrow but not what happens in a year or two? Or do you think that we don’t have enough evidence to be terribly concerned about vascular and organ damage?
I have been reassured by calm, thorough debunking of some of the more alarmist worries about covid (for ex about immune system damage) debunked - but have seen nothing debunking the worries about vascular damage. Can we afford to risk repeated exposure to a virus that does that kind of damage? Or do you believe that worry to be overblown?
Also we recently learned EBV can cause MS, like chicken pox and shingles. Do we know yet if covid normally persists the way EBV and chicken pox do? I have read about viral persistence in long covid, but is it known if the virus is cleared in most people who recover within a few weeks?
Seems unlikely. It's more of a thing with herpesviruses, which Covid isn't.
1000% same. This is a cardiovascular disease. We can’t continue to “mitigate personal risk” without increased ventilation, filtration etc in all public spaces. If others are willing to roll the dice on increasing their risk of stroke, heart attack, disease, diabetes - so be it 🤷🏼♀️ but I can’t enter a public space right now (and nor can my kids) without risking long term health impacts.
I have the same concerns and would love to hear Dr. Jetelina's thoughts about this.
I totally understand where you are coming from, and I don't think we have done enough to mitigate risk, but I also understand why it isn't an official emergency anymore. As Dr. Jetelina alluded to, if we keep calling it an emergency, people will not listen when we have another health crisis situation.
Where I live, in the Hudson Valley of New York, Lyme Disease has been doing much of what you speak of for a long time. I would love for it to be treated as more of an emergency.
I wish I lived in a society that put greater value on protecting the vulnerable. With COVID being triple the risk of the FLU, it’s a small ask for people to mask up in public spaces during times of high transmission (measured in the wastewater). Society has moved on, but the elderly and the immunocompromised can’t. While I appreciate the reasons that we are no longer in an emergency phase, I continue to be saddened by the lack of concern that one might transmit the disease to a vulnerable person causing them a lifetime of long covid. I know personally of far too many who continue to suffer. I don’t want to be a vector in the transmission chain, so I will continue to mask when COVID levels are high in wastewater.
I track wastewater in my hometown to keep track of COVID levels:
https://lauraspandemicponder.com/
Hi Paul- Appreciate the comment. In regards to #2 three solid studies have compared the presence and symptoms of long COVID to post-viral influenza. All three found that long COVID is more common and more severe than post-viral influenza. In one U.S. study, post-viral symptoms were 65% higher after SARS-CoV-2 than the flu. Here are the links to the studies: https://yourlocalepidemiologist.substack.com/p/long-covid-mini-series-burden
It is important not to dismiss Long Covid nor overstate it’s prevalence.
Long Covid is certainly real, but it is a disservice to those affected with Long Covid to inflate how many people suffer from Long Covid.
Unfortunately, many in public health, including the CDC [1] as well as respected medical journals [2] continue to repeat incidence rates that likely overestimate frequency by several magnitudes.
The CDC regularly cites “10%, 20%, and 30%” rates, I suspect it is likely much closer to 1 in 500 (.2%). For readers of YLE, this likely sounds like an extraordinary claim, as the 10%-30% rates have become nearly embedded in the Covid Zeitgeist as a self evident truth, but I think a simple examination of the source of the claim followed by some thought experiments can close the rate gap between perception and reality.
Source Claim Evaluation:
First, let us review where these high incidence rates come from: surveys. Self reported surveys. The bottom tier of the scientific pyramid of evidence.
From the earliest Long Covid studies [3] to the most recent [1], we keep finding that self reporting drives these incredibly high rates.
Greenhalgh et al in “Management of post-acute covid-19 in primary care” (Aug 2020) writes “Around 10% of patients who have tested positive for SARS-CoV-2 virus remain unwell beyond three weeks” which was based on self reporting of an unknown set of patients in the UK who were hospitalized with acute covid early in the pandemic and then given an app from Zoe Health so they could log how they are feeling daily. [4]
I recently downloaded the Zoe app with the intention to log in daily and report symptoms of which there are 14 choices like hair loss (apparently then I have had Long Covid since 2016), lower back pain, depression, drowsiness, rashes, etc. By day 3 I forgot to login already, which is likely what everyone else who feels fine would do – forget to report to the app they feel fine. Sick people are far more likely to login.
The CDC writes “Nearly One in Five American Adults Who Have Had COVID-19 Still Have “Long COVID” (Oct 2022), citing the ongoing Pulse census survey [5].
Reading through the technical notes of the Pulse survey, a more accurate title for the CDC report would be “Of the 1 in 25 people who responded to our survey, Nearly 1 in 5 people self reported long Covid”.
That exposes one of the simple flaws of a survey, selection bias. Of the roughly 40,000 people sent the Pulse survey, only 4% responded. Looking through the questionnaire [6], it is easy to see why there was such low response rate as you apparently have to go through a staggering 39 pages of questions to complete the survey. (And perhaps explains why in the Limitations they note: “The response rate for the Household Pulse Survey was substantially lower than most federally sponsored surveys.”)
Who has time or motivation to complete such a survey? People who want their voice to be heard which heavily biases those with Long Covid.
It is no different than the common Sales aphorism that “a happy customer tells 1 friend, an angry customer tells 10”. In this case if you had Covid and feel fine, you will be less inclined to wade through a 39 page questionnaire than someone who has been unable to work since their illness.
For those who believe they feel fine and still decide to complete the survey, it’s possible another problem of surveys - “response bias” - will capture people who didn’t even realize they had Long Covid until the survey phrasing lead them to affirm a positive response.
Consider the vagueness of symptoms of Long Covid the Pulse survey lists on page 12 (PASC2):
“tiredness or fatigue, difficulty thinking, concentrating, forgetfulness, or memory problems (sometimes referred to as "brain fog", difficulty breathing or shortness of breath, joint or muscle pain, fast-beating or pounding heart (also known as heart palpitations), chest pain, dizziness on standing, menstrual changes, changes to taste/smell, or inability to exercise.”
Who hasn’t felt those symptoms in the past 3 months? I would be shocked if you randomly chose 100 people in 2019 and forced them to complete this survey you wouldn’t get at least a 20% affirmative response to this binary “yes or no” question. Indeed, similar scrutiny has found “post viral syndrome” following pneumonia [7], “long strep” aka PANDAS following a streptococcal infection in children.
I am also unclear if later questions of the survey can trigger a “positive for long covid” flag, consider the health questions starting on page 26 such as ”Over the last 2 weeks, how often have you been bothered by... Feeling nervous, anxious, or on edge?” Would selecting “yes” also group in you Long Covid group? I am not sure (if anyone wants to put a second or third set of eyes on this, much appreciated).
This skepticism is no different than how I approach vaccine injury claims. If someone tells me that 1 in 5 children suffer an injury following varicella vaccination, and upon scrutinizing their claim I see that this was based on parents choosing to reply to a survey, I would immediately (and correctly) call out the massive selection bias. This is why I remain skeptical when people use VAERS self reporting to argue against Covid vaccination. That skepticism needs to be applied equally to all claims, even against he ones we favor.
__________________________
[1] Nearly One in Five American Adults Who Have Had COVID-19 Still Have “Long COVID” https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm
[2] Long COVID: Rapid Evidence Review
https://www.aafp.org/pubs/afp/issues/2022/1100/long-covid.html#afp20221100p523-sort3A
[3] Management of post-acute covid-19 in primary care
https://www.bmj.com/content/370/bmj.m3026.long
[4] https://covid-webflow.joinzoe.com/post/covid-long-term
[5] https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm
[6] https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/Phase_36_Household_Pulse_Survey_ENGLISH.pdf
[7] https://pmj.bmj.com/content/postgradmedj/64/753/559.full.pdf
On the whole YLE has given us a comprehensive well grounded perspective in the evolution of the COVID pandemic. In my public health informed opinion I agreeit is appropriate that the "Covid Emergency" be brought to an end - extending it to May 11 is an act of generosity. This is because technically, scientifically, and in a public health sense across the country the case rate is low and there is now no surge and no new dangerous variants now or on the horizon. Also we probably have not yet reached endemicity. Case rates are low but the data is unreliable because of home testing. The current level of hospitalizations and deaths is low compared to the last three years (and may even never get lower.) Ongoing deaths will occur. Most importantly the general public (not to mention the Chamber of Commerce and the Republicans), having burnt out and been unsupportive and noncompliant when there were real risks with surges, will NOT want to pay attention now. There is no national political will or force to continue the emergency and plenty of corporate and Republican opposition.
The big problem is that the White House's policies and messaging is very deficient (to agree with the KFF observations cited). They have
(1) no announced and publicized public plan to monitor for a surge or dangerous variants (with transparent criteria and thresholds),
(2) no public plan to develop or approve a better vaccine on an accelerated basis (like the new, better Indian intranasal vaccine),
(3) no specific plan to increase vaccination acceptance and levels of Americans with the better booster,
(4) no public health strategy to protect high risk individuals (especially now that Evusheld is ineffective and off the market). They are not even articulating the importance of societal and neighborly protection of these 7 to 15 million Americans.
(5) no public, national plan to deal with deferred evictions,
(6) no national plan to deal with the 100,000s of people and children who will lose health insurance or be unable to afford ongoing home rapid tests or Paxlovid or vaccinations at commercial rates.
(7) Much NIH research but no plan to support people with LONG COVID now or to deal with the loss of their labor to the workforce,
(8) No plan to deal with the national trauma of over 1,000,000 deaths and the millions of affected family members. There is no discussion in the public square about this issue - like it never happened. (See MarkedbyCOVID.org).
(9) The COVID emergency totally demonstrated the shortcomings of our commercial, market oriented health care insurance by the need for the feds to bail out both providers and patients with huge amounts of federal cash to provide needed COVID medical care. We need to avoid any return to the old system and create a federal universal not for profit health care system on the traditional Medicare or a public utility model. It seems federal policy is unwilling to even admit this truth.
Thus there are lots of specific issues that concerned citizens and activists must pay attention to at this time of transition.
I agree with you. The comms around this is atrocious
Bless your work. You are doing everything you can.
The only creative idea I can think of is for you to gather a few like minded people and have a NATIONAL TOWN HALL live steamed and on CNN or MSNBC with 5 min fact segments followed by 10 min open discussion of each issue from panelists and audience! It could change the national conversation on these issues. GAME ON?
I've actually proposed this to NPR. But maybe you're right; need it with video on.
Dr. Gordon, this is truly an excellent list of concerns. Thank you so much for weighing in. May I add a friendly amendment to #4, which is that it also does not appear there is any strategy for, or even clear communication to, those of us at higher risk because of age? That cohort is, if I recall correctly, 16% of the population. At this point, and actually not for some time, have I expected societal support, but it sure would be helpful if our federal, state, and local public health departments gave us guidance and information targeted specifically to those of us at higher risk. I’m reminded of Dr. Jetelina’s comment when the CDC changed to Community Level maps: “This map tells us when to take collective action so hospitals don’t surge. This does not tell us when to wear a mask for individual protection due to high transmission. If we are trying to prevent severe disease, those at most risk should know when they are at risk for infection.”
Great addition to the article, overall I wish I could like this twice. One disagreement I have is with respect to point #9. We don't just have a for-profit healthcare system. We have a mixed bag of partly socialized and partly insured and partly privatized and it's not working very well. Yes, there are benefits to fully socialized healthcare but there are also significant costs on an individual level and opportunity costs. I don't think there is enough recognition of the benefits derived from innovation related to for-profit healthcare and pharma in the US both for the US and the world. I agree though that the system as it is now has a lot of problems, I just don't believe in throwing out the baby with the bathwater. I would like to see a discussion about which model would best preserve innovation and the benefits that capitalism can bring while avoiding the downsides.
Thanks! Katelyn liked it too. Considering some action steps!
My hot take on single payer vs status quo:
There's a thing that Medicare does when it finds that someone has other coverage - crossover claims. Either they forward the claim, or in some cases Medicare will front the money and recover it from the private payer. Of course, that's all predicated on the claimant having Medicare. Why? Let's blow the system open to people who don't have Medicare. If they don't, HHS and the IRS surely have everything they need to determine the correct payor. This would have all the administrative simplicity of single payer, but without the extra costs.
Two points:
(1) Health insurance company contracts of insurance all generally have clauses that they are secondary payers in some circumstances, e.g. injury due to auto accident caused by others, or work place injury under work comp insurance. I believe Medicare law requires if an enrollee is dually insured Medicare is secondary.
(2) If it were not for the vigorous lobbying and political opposition of all the corporations and companies making money on the present system (UnitedHealthcare had a $20 billion profit !!!! in 2022) the easiest and simplest, and most rational road to single payer would be to enroll all Americans in traditional Medicare and make some moderate improvements.
Except that's not happening any time soon, since it would require statutory changes. Blowing crossover claims wide open would be a fair alternative and could be implemented administratively.
Do you think ending the "emergency" in May (instead of today) is to allow time for a possible XBB.1.5 surge in the next few months?
To the extent people increasingly forego vaccines and boosters, and to the extent vaccine protection wanes, our immunity wall will increasingly depend on natural immunity. It seems Public Health’s unspoken assumption is that in order to build a strong and durable immunity wall, it is necessary for those at lower risk to acquire some level of natural immunity to protect the more vulnerable members of society.
This is an important comment. You have a game plan right here on what needs to be done before the next pandemic. I am distressed that much of this is not being looked at.
After reading this post, I became a subscriber. I have been reading for a while with appreciation but hesitated adding yet another subscription to my growing stack of expenses. But your willingness to be bold in speaking about the need for societal reform when it comes to healthcare pushed me here immediately. Thank you for your voice.
"We need to invest in better filtration and ventilation."
Has literally anything been done in this regard? I see a lot of talking about its necessity but have never seen anything talking about any progress, other than some schools buying portable air filters.
On an anecdotal note, I (childless) only see those filters in some medical settings and ... all over Koreatown. That's it. Is there any invisible progress being made?
Yes, there is progress being made, but certainly in pockets. Dr. Joseph Allen (Harvard) is one of the biggest advocates for this. In fact, he was writing about this in March 2020, just no one was listening. He updates on his Twitter about progress. Also has a good website.
I was asking myself this recently when auditing a class at a very wealthy Ivy League university where hundreds of kids (no masks) were crammed into a big lecture hall with all windows shut. With an endowment in billions why not lead the way with indoor air quality mitigation? Apparently this is just not a priority.
It would be helpful to know if there was a repository of air cleaner, air handling devices that are effective in killing the SARS-Cov virus. I am aware of only two of them, UV-C and one based on PHI (photo-hydrogen ion generation, utilizing LEDs to generate the ions off of a proprietary device with a single generator device placed in the primary ductwork. disclaimer: I don’t sell such devices, but I am aware of these devices and we have used them in our home air handling system. We installed the original device with UVC/PHI combined many years ago and upgraded to the latter recently. So far so good, but we still wear masks in “crowds”(more aptly described as gatherings in our case) in enclosed Spaces. We practice distancing/handwashing and believe in the vaccines plus boosters. There is no rule that you’re only allowed one Level of protective armor. some commercial entities use, larger scale devices, most of which are the UVNC version, but I am aware of the second variety being exported to China and also used to control unwanted mold in certain cheese factories operated by the Dutch.
As an individual, I can't solution for better filtration in public spaces, especially schools (because of how they're funded) and privately owned spaces (like big box stores and hospitals).
I am saddened that the recommendations given here fail to mention filtration at any other level of responsibility besides an individual's onus. This is a tremendous misstep.
Thank you for another wonderful post. I appreciate the thought you put around what phase we’re in given our uncharted territory and lack of formal definition.
Dealing with Covid is our new normal. What I struggle with is knowing how bad transmission levels are around me. What’s the most reliable indicator? In my country, the wastewater chart (logarithmic) is at an all-time high (worse than January 2021) even though our CDC score (based on hospital bed capacity) is “low.” We’ve had a ton of rain this past month, which makes interpreting the chart iffy. Deaths are also low, thankfully, but they are backwards looking by 3+ weeks. I’ve been trying to do as much social stuff as possible outside for the last 3 years, but at some point I’ll need to return to indoor dining and events. It would be nice to know I’m doing so when transmission levels are low - but where’s the best place to find this out? Case counts are no longer reliable, and test positivity isn’t always readily available.
I’m also curious, any update on XBB.1.5? Will we have a second winter surge, and if so, will it be worse than the post-Christmas wave? Or is our immunity wall holding up better than expected?
Unless your municipality is mixing storm drain water with sewage fluids and sending both to the sewage treatment facility, the fact that "it has rained a lot" would not seem to have much impact on interpreting COVID monitoring data coming out of your sewershed.
Thanks! I don't know whether storm drain gets mixed with sewage fluids - probably not because all the rain would have diluted the wastewater and lowered the amount of covid particles on the chart. Below is a link to the chart in case you're interested, although you have to scroll down quite a ways to see the wastewater chart, which is logarithmic. It does look like it might be nudging down a little, hard to say. Also, don't people excrete virus for a while after they've had covid - probably, but for how long (weeks or months)?
My sense is my county does a great job collecting and providing information, yet it's still hard to know transmission level. My county also does a lot of other wonderful things from an equity point of view, such as free Paxlovid to the uninsured.
Here's the link to the wastewater chart:
https://coronavirus.marinhhs.org/surveillance
So one way around this possible dilution is what biobot does - they benchmark everything to a harmless plant virus that passes through the guts of animals, called "pepper mild mottle virus".
"At this rate, SARS-CoV-2 will be the fourth leading cause of death in the U.S. in 2023..."
This always bothered me. Heart disease and cancer aren't "one thing". They're a category of many different ailments, all lumped together. Accidents I have to assume are the same. Yet COVID-19 is a very specific single ailment. In previous years it looked fairly clear that one could declare COVID-19 the biggest single cause of death. Would be interesting to see when _that_ might finally stop being the case.
a very valid point. see my comment for a related concern about misleading comparisons.
500 people a day. Thanks, as always, for painting a complete picture.
Yeah, 500/day.
If 500 people a day dying from COVID-19 doesn't warrant continuing an emergency approach to this infection, I wonder how many dying a day would.
750? 1000? 2000?
Are we now so inured to this disease that we now consider 500 people dying a day not an emergency?
apparently. sadly
Over that recently as a matter of fact. Much higher than it was in the Summer of 2021 when we had vaccines but were still very, very scared. And that was before Delta and Omicron. The fact that they are no long as devastating doesn’t mean we should relax. Think back.
As we leave behind the emergency phase, it's so striking that COVID is Top 5 for causes of death, right above stroke! You're conclusion that we are also *LESS* prepared for the next pandemic due to lack of trust, misinformation, etc is quite sobering and should inspire us to do better.
Regarding the top 3 killers in this country, it would be interesting to see people’s behavior if we phrased it this way:
By getting vaccinated and boosted, and by being careful in crowded indoor spaces, you can reduce your risk of dying from Cancer by over 90%.
I would do that.
Same for heart disease. Accidents. If only it were that easy for these top killers.
It kind of is that easy, for most of us, with Covid.
Glad you said “kind of”. I am a fervent believer both in mask wearing and vaccination. But I confess, whenever I do wear a mask - which is seldom since I avoid almost all contact that might require it - I find it uncomfortable (physically) and I can readily understand the urge to not bother. After all there are many health improving things that we could do - exercise, eat better, etc. - but many of us don’t do them either, even though we know the longer term benefits.
Thank you for this helpful perspective. Yes, we will (hopefully) be in this in-between, transition phase for years to come. Please share if there are ways we can help to support improvements as we go forward. With gratitude.
NIce piece, but depressing in that "the emergency is over" thinking will end up increasing deaths still more. And while I agree that innovation in vaccines is needed, we also need to focus on developing drugs that *kill* coronaviruses. There was much optimism about this a year or so ago; now everything has gone quiet. Which is strange, because any research group or pharma company that develops such a drug will make a fortune. Might be nice to write a piece on the state of play WRT developing new ways to stop Covid, etc (not solely vaccines). Thanks Katelyn, and keep up the terrific work.
Where is the evidence that providing food to countries experiencing famines reduces deaths? The covid emergency enabled people of all income levels, with/without health insurance, to get lifesaving vaccines, therapies, tests, and to get some financial support to help if they’d missed work due to illness, etc.
This is a great post - thanks! Can you write a follow-up post about living in this "transition" world with an individual-centric set of guidelines for navigating life - with the aim of aggressively minimizing the probability of encountering long-COVID in our lives?
Right now, all I can think of is that catching COVID is bad - because it *may* lead to long COVID with a 1/300 probability (like you've written about earlier). But it leaves me feeling exposed and without a sense of control. I know if I get influenza, there are certain things I can do to minimize complications - even though tamiflu may or may not work, it's worth taking; and even though post-viral syndromes exist even with influenza, it hasn't felt historically scary like this.
- Recently FDA has moved to change COVID-19 vaccination schedule to be annual, and you wrote about it recently. Are there strategies we could undertake get non-updated vaccines more frequently if we wished (perhaps with the help of a friendly physician's referral and out of pocket costs) to reduce our exposure?
- What are the best tactics for leveraging Paxlovid in our lives? I've read in some places that a 2-week course is more effective than a 1-week course, but it all sounds very anecdotal, and I've ignored it (we've avoided COVID-19 successfully, in part thanks to columns like yours, so haven't needed this yet).
- How do we manage travel, and in general, taking risks in environments where we may expose ourselves to COVID-19 (like restaurants, parties etc.)? Is the only solution to mask-up, and avoid flying to Australia? ;-)
As someone who recently tested positive for Covid after 2 1/2 years of cautious living I really appreciate your thorough and objective delivery of this information.
I had to fly from Calif to Florida to visit my brother in the hospital and on the flight home had a passenger on my left, masked , coughing and sneezing and on the right across he aisle I had a fellow umasked coughing and sneezing .
I was double masked most of the time unless single masked or eating. tested positive three days after getting off the plane.
I am fortunately having light symptoms and even though 73 I am in pretty good health and not experiencing severe reactions.
We are definitely NOT over the pandemic despite America's frightening ability to choose to believe what matches their wish list rather than what is actually occurring.
Like the captain on the Titanic, we continue to believe that we can transform this continuing serious Covid infection - "glacier" of a problem into a "fogbank" because we " want to". Just as with Climate Change, Homelessness , Racism, and the Income disparity, " Don't Look Up !" got it right!
Thanks for your work and commitment
Bob H
I had hoped we'd get a decision about when vulnerable seniors, like me and my husband, can have our 2nd bivalent booster. Our first was 4 months ago. Advice, please! (No comments by pro-Covid folks are wanted.)
We have the same question. We have answered it for ourselves, after reading what FDA advisors are saying, that the first chance will be next Fall. Some experts would even like to skip it altogether, because they don’t believe it significantly improves protection. Despite the talk of seniors being given two shots a year, I think we’ll be lucky to get one. The talk is just talk. And if it came to pass the benefits of reducing infection/transmission wear off so quickly that 2 a year wouldn’t be enough to help much if at all.
I did see the "next fall" notion... but is literally no one researching how to protect vulnerable seniors? I just might visit a pharmacy--not the one were we've had our previous vaccinations--and ask for a bivalent. If they ask what vaccinations I've had to date, I could say, "None. My grandson just persuaded me I should get one." (Do pharmacies share their vaccination records? I hope not!)
Geez, this reminds me of trying to score marijuana in 1966 and wondering when it'll finally be legalized.
Yes, I’ve has the same idea. In fact, somebody on this newsletter, responding to my question about how to get extra shots, said he just went to the pharmacy (the same one) and got another shot, no questions asked. I think just saying I don’t have my card or i can’t find it would work too. my impression is that the pharmacies don’t do a very rigorous job of policing it.
I've done that a few times.
The only party that could conceivably be "harmed" by this would be your insurance company.
My insurance company, I think, would rather pay for another vaccination than for COVID treatment in the ICU. ;)
Yup. I think that's why they don't mind. Gotta love those actuaries
Hurray!!! That's what we'll do, then.